التعامل الخاطىء مع خلع مفصل الورك عن الاطفال - Wrong approach to DDH, البروفيسور فريح ابوحسان - استشاري جراحة

Freih Odeh Abu Hassan F.R.C.S (Eng.), F.R.C.S(Tr.&Orth.)

Professor of Orthopedics and

Pediatrics Orthopedics Surgery

University of Jordan

Developmental dysplasia

But not developmental dislocation

And not

developmental disturbances

1- Jordan University

Dislocation

Subluxation

Unstable hips

Hip dysplasia

Acetabular dysplasia

Jordan University

Dislocation at birth

1- Neuromuscular disorders

(AMC , Spina bifida…….)

2- Sacral agenesis

3- Syndromatic, Larsen….

Jordan University

Jordan University

2- Jordan University

Suspicion from hx. •Female

•Family hx 10 times

•First born

•First presenting part

(F.Breech) 5-10 times

•Feet deformity

•Fetal anomalies

•Facial asymmetry

•Faulty gait !!!!!!!!

•Family habits

Family habit

Jordan University

Suspicion from Exam. • Limited abduction

• Unilat. groin crease

• Short leg

Jordan University

10-20% has DDH

Clinical Dx

-Ortolani

-Barlow

3- Jordan University

Jordan University

•1st 3 months.

•Negative in A.D.

•Only +ve for dislocation.

•You should examine each

hip alone.

Jordan University

Jordan University

-Harmful ,Done once

-Used with USS !!!!!

Jordan University

Crying

Tense

Hungry baby

4-

Child problems

Jordan University

= Hurried doctor

= Little experienced

= Poor understanding of the tests

Treating Doctor problems Jordan University

Jordan University

*Business motivation !!!!!

*Not before 9 weeks.

*Iliac line must be vertical.

*Cost !!!!!!

5-

Jordan University

*Needs the (Orth.) expert !!!!

*Dynamic more conclusive

*If you depend on it you may

treat more normal hips !!!

Jordan University

Jordan University

6-

X-ray at 2-3 M

• Diagnostic.

• Easy follow up.

• Cheap.

Jordan University

Jordan University

*Protective shield

*Where is the O.N?

*High AV angle !!!!!!

*ABDIR 30, 15.

*Pelvic tilt

Normal acetabulum

No DDH

Who is responsible?

Jordan University

Normal acetabulum

+ Dislocation

Not DDH

Pathological dislocation

Jordan University

+ve Pregnancy +ve DDH

High anteversion *Straight neck-shaft angle

*O.N Symmetrical

*Disturbance of Shenton’s lines

7-

False pregnancy

Intoe gait

Jordan University

High Crescent Jordan University

Jordan University

Full abduction doesn’t

mean no DDH.

Normal acetabulum

means no DDH

Jordan University

1-Von-Rosen

8-

2- Pavlik Harness Jordan University

3-Double Napkins

Treats only normal hips

4-Ilfeld/ Craig

Problems

= Can’t reduce hips

= AVN

= Long R/

= Abd. Position only

= Frequent removal

Jordan University

Frejeka pillow

Jordan University

Flexion

* Bad 1st look from the parents.

* Poor manufacturer.

* Doctors hate it !(Doctors problem)

*Simple, Safe, Easy.

*Needs only orientation.

*Acceptable by the parents.

*Very effective.

*Short duration of R/

*No need to be removed .

Jordan University

1-We don’t know the Diamonds !!!

2-We don’t know how to use

the Diamonds properly?

3-We have other cheap Jewelry!!!

4-We have sensitivity to Diamonds.

Jordan University

* Teratologic dislocation ( CDH)

* >6m, Obese child

*Failure of reduction after 4 weeks.

* Irreducible dislocation.

Jordan University

9

Lorenz

Jordan University

Human

Position

I am sorry!

I am out.

Cut the doubt by 2 cuts CT

In or Out

Jordan University

How long you will keep the spica ?

1- After closed reduction

6 W + 6 W

2- After open reduction

6 W

Jordan University

Spica Problems

1- Osteoporosis fracture

2- Can hide unreduced hip

3- Hip stiffness

4- Pressure sore

5- Hygiene problems

6- Heavy

7- May break

Jordan University

The mother of the crisis

Jordan University

Jordan University

Dirty spica

Minimal injury Jordan University

Don’t examine the hips

After removing Spica!!

Only AP Pelvis and hips X-ray

Jordan University

Surgeon did inform the parents ,

Probably I did break his bones !

I will do X-ray next week !!!!

Surgeon’s fracture

Rehabilitation fracture

Avoid passive movements

R L

Radiographer fracture

Don’t Force the reduction !!!

= False reduction

= AVN

= Fracture

= Redislocation

10 Jordan University

11

All dislocated or subluxed hips

coming for closed reduction

Jordan University

Jordan University

12

Jordan University

Your child had poor incision

Wrong Bikini

Femoral

head

Femoral

head

13

Time will tell !!!!!!

Follow up till maturity

Jordan University

= DDH is very common.

= Needs a warness in Dx.

= Wrong R/.disability.

= Would you allow this to be

done for your child?

= Pavlik harness.